Ending canine-mediated human rabies: the time is now

Dr Bernadette Abela-Ridder works at the World Health Organization as the Team Leader of the Neglected Zoonotic Diseases in the Department of the Control of Neglected Tropical Diseases. She is the WHO Focal Point on Rabies.

Human rabies transmitted by dog bites is a daily disaster for underserved and rural populations, especially children. Rabies is 100% vaccine-preventable in animals and humans. Most cases can be prevented through vaccinating dogs, avoiding being bitten by dogs, and raising community awareness. Yet rabies remains a neglected disease.

It is time to address that neglect. Stakeholders, in the drive to eliminate rabies, will be doing just that at WHO headquarters in Geneva during an international conference on the Global Elimination of Dog-Mediated Human Rabies on December 10-11. Many are joining forces, not only because rabies control is a worthy cause, but also because it is possible, illustrating a public health success driven by coordinated action between the veterinary and human health sectors.

The conference will confirm that “yes”, it is possible to eliminate a disease that haunts underserved communities. Lessons learned through proof-of-concept programmes in Bangladesh, the Philippines, South Africa (KwaZulu-Natal province), and Tanzania have demonstrated significant reductions in the number of human and canine rabies cases. Zero human cases have been recorded in KwaZulu-Natal and on the island of Pemba in Tanzania since 2014, and a 50% decrease in human rabies deaths in Bangladesh has been achieved over just 3 years. The Government of the Philippines has declared three island provinces, five island municipalities, and four other islands rabies-free.

The success of these rabies programmes has been driven by a concerted effort to generate evidence to inform national policies and to encourage political commitment at the country level. Various strategies have been adapted and home-grown solutions found for tackling problems and identifying opportunities to embed rabies within broader services and systems.

Dog vaccination is the most effective intervention against rabies, decreasing rabies in dogs and having a direct impact on public health by decreasing transmission to humans, in whom the disease is uniformly fatal. Those who are bitten by an infected animal invariably die a slow, painful death, unless they receive post-exposure prophylaxis before symptoms develop. Post-exposure prophylaxis is costly yet justified: there is no other cure.

The Global Elimination of Dog-Mediated Human Rabies conference will be jointly hosted by WHO, the Food and Agriculture Organization of the UN, and the World Organisation for Animal Health, and supported by the Global Alliance for Rabies Control. The conference will advance the agenda towards the elimination of human rabies transmitted by dogs. Globally, it is time to End Rabies Now.

Comments

Good Governance for Rabies Security
1. Span: Target vaccination and dog control coverage is at maximum extent- i.e. entire province-country-region
2. Speed: One Day to One Month full-time programs are desired, rather than prolonged (years) and discontinuous or interrupted
3. Supplies-Skills: Key supplies and skilled persons are readied and available at all times. Cold chain is a must
4. Societal Support: Whole-of-community engagement and partnership is a key success determinant
5. Sustainability: Rabies Security requires unwavering political, societal and strategic determination- to be sustained until rabies threats and risks become negligible

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